Psychopharmacology in Pregnancy and the Postpartum Period

A substantial minority of pregnant and lactating women meet criteria for one or more mental health disorders and, in many of these cases, treatment with psychotropic medication is indicated. Data from empirical studies on psychopharmacology using antidepressant medications for perinatal women suggest that the risk-benefit ratio is favorable, although their usage during pregnancy is associated with a slight increase in risk of spontaneous abortion, cardiac malformations (specifically with paroxetine), preterm birth, and poor neonatal adaptation syndrome. However, these risks should be contrasted with the fact that women with moderate to severe depression who have had multiple lifetime episodes have a substantial relapse rate if they stop taking their antidepressant during pregnancy. There is more limited research on the use of other classes of psychotropic medications during pregnancy and the postpartum period. Future research should establish the efficacy and risk-benefit profile of psychotropic medications for the broad array of mental health disorders during pregnancy and lactation, as well as for postpartum mental health disorders other than depression.